MEDICARE: JASON A PECK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	2003-00865	NC

General Provider Information

NPI Number	:	1972524361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON A PECK M.D.

Provider Business Mailing Address
First Line	:	8037 CORPORATE CENTER DRIVE
Second Line	:	SUITE 400
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4550
Country	:	US
Telephone Number	:	704-659-1052
Fax Number	:	888-869-6879

Provider Business Practice Location Address
First Line	:	8037 CORPORATE CENTER DRIVE
Second Line	:	SUITE 400
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4550
Country	:	US
Telephone Number	:	704-659-1052
Fax Number	:	888-869-6879

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	03/14/2016

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